Hydrocele

Definition

A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of skin underneath the penis. Hydrocele is present at birth in about 1 in every 10 male infants; however, within the first year of life, this condition usually disappears without treatment. Because of inflammation or injury within the scrotum, men that are older than 40 could also develop hydrocele.

In most cases, hydroceles are painless. Hydroceles may require no treatment because they are usually harmless. However, a person should see a doctor in case he has scrotal swelling in order to rule out other causes including testicular cancer.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The painless swelling of one or both testicles is often the only indication of a hydrocele.

Causes:

A hydrocele could develop in baby boys while they're in the womb. The testicles will descend from the developing baby's abdominal cavity into the scrotum, at about 28 weeks of gestation. Each testicle will be accompanied by a sac (processus vaginalis), which will allow fluid to surround them.

The sac will close in most cases, and the fluid will be absorbed. Noncommunicating hydrocele occurs in case the fluid remains after the sac closes. Fluid can't flow back into the abdomen because the sac is closed and within a year, the fluid usually gets absorbed.

The sac could remain open in some cases. The size of the sac could change, or fluid could flow back into the abdomen in case the scrotal sac is compressed, a condition known as communicating hydrocele.

Inflammation or injury within the scrotum could cause a hydrocele in older males. Infection of the small coiled tube at the back of each testicle called epididymitis or infection of the testicle called orchitis could cause inflammation.

Complications

Complications:

In most cases, a hydrocele doesn't affect fertility and isn't dangerous. But in some cases, some serious complications could be caused in case it is associated with an underlying testicular condition. Those complications may be:

Inguinal hernia:
A life-threatening condition could be caused when a loop of intestine becomes trapped in the weak point in the abdominal wall (strangulated).

Infection or tumor:
Sperm production or function could be impaired by an infection or a tumor.

Treatments:

Usually, within a year, hydroceles in baby boys disappear on their own. However, hydroceles may need surgical removal in case they don't disappear after a year or if they continue to enlarge.

Hydroceles in adult males also go away on their own. Only when a hydrocele gets large enough to cause discomfort or disfigurement it requires treatment or removal.

Some of the available treatment options include:

Needle aspiration:
The fluid in the scrotum could be removed with a needle. Because the fluid usually returns, this treatment isn't widely used. To prevent the fluid from returning, an injection of a thickening or hardening (sclerosing) drug could help. This injection should be done after the aspiration. Men who have risk factors that make surgery more dangerous could use this method. Infection and scrotal pain are some of the risks of this procedure.

Hydrocelectomy (surgical excision):
Using general or spinal anesthesia, a hydrocele could be removed on an outpatient basis. To remove the hydrocete, an incision could be made either in the scrotum or lower abdomen. When a hydrocele is detected during surgery to repair an inguinal hernia, it could be removed even if it's not causing any discomfort.
For a few days after surgery, the person should have a drainage tube and wear bulky dressing over the site of the incisionFor a period of time after the surgery, the person may also be advised to wear a scrotal support. To reduce swelling, during the first 24 hours after surgery, ice packs should be applied to the scrotal area. Blood clots, infection or injury to the scrotum are some of the risks of surgery.